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Uncle JT’s Secret Teachings - 173 - Minor Xianxiong Decoction Syndrome
Minor Xianxiong Decoction Syndrome
[8.17] Minor “Jie Xiong” disease, located under the heart, painful upon pressure, with floating and slippery pulse, is treated primarily with Minor Xianxiong Decoction.
Minor Xianxiong Decoction Prescription
Coptis chinensis (Huanglian) one liang (~37.5g), Pinellia rhizome (Banxia) half sheng (~120ml), one large Trichosanthes fruit (Gualou shi). The three herbs are decocted with six sheng of water (~1.8L). First, decoct the Gualou to get three sheng (~900ml), then add the other two herbs, decoct to obtain two sheng (~600ml), strain, and take warm in three doses.
The minor “Jie Xiong” disease is located under the heart and is painful upon pressing; without pressure, it does not hurt, which is much better than major “Jie Xiong.” Major “Jie Xiong” causes unbearable pain even without pressing. It is like peritonitis which is extremely painful but unpleasant. However, minor “Jie Xiong” involves a specific area; if you tap or press this bone or area, and if there is heat pathogen inside, there will be tenderness; if there is no heat pathogen, it is a different syndrome, and there will be no obvious tenderness. Tenderness occurs only with real heat.
The pulse is floating and slippery. I think because this disease mainly affects the upper burner, the pulse tends to be somewhat floating. When pressing down, because of the hot phlegm fluid, the slippery pulse of phlegm fluid can be felt, so in clinical practice this floating and slippery pulse is acceptable. But if there is no floating, slippery pulse is enough. Of course, you can also consider whether the patient has yellow tongue coating and such, combining these signs for diagnosis. For minor “Jie Xiong,” I think we can use it well. I also just told students that stomach inflammation, cholecystitis, bronchitis, cough, coronary heart disease, myocarditis—all diseases within this pathway can apply this. Just press it; if you can feel it, you gain something. Even if it’s Alzheimer’s, if you can feel it, you gain something, right?
Talking about the prescription structure of Minor Xianxiong Decoction, the key is a lump of Gualou shi. To effectively use classic prescriptions clinically, a lump of Gualou shi is quite heavy. Today, to make it effective clinically, you probably need to use more than 45 grams per day, and the Gualou shi must be crushed thoroughly, including the seeds. If you just decoct Gualou shi without crushing, the effect is still poor. Paying attention to this, the formula will be very useful.
Banxia is easy to understand. Because there is no fresh ginger in this formula, you need to scald Banxia with hot boiling water first. Using raw Banxia helps resolve phlegm-fluid better, but you must first crush it, then sift it and rinse it in hot water like dipping thin slices of meat in hot pot before decoction, because there is no raw ginger, so be careful. Huanglian clears damp-heat and can also act in the region of the heart—on the invisible heart. This structure can resolve the hot phlegm-fluid obstructing this area. When you understand the use of Minor Xianxiong Decoction, if it is not a heat syndrome but a cold syndrome, we can finish the chest bi (chest obstruction) chapter very quickly today.
Treatment of Chest Bi Syndromes
In the chest bi chapter, I will teach you a simple differentiation method, just listen casually and you will get it.
First, chest bi actually refers to what we are discussing today as heart disease. Today, I will also teach you heart disease treatment methods. The first group of heart disease medicines includes Gualou Xiebai Bai Jiu Decoction and Gualou Xiebai Banxia Decoction; call these Group A. This Group A is such that although the main symptoms say chest pain or pain piercing to the back, actually many people—does anyone in your family have heart disease? When their heart hurts, it feels like gripping pain connecting to the back.
When we use the Gualou Xiebai system, we don’t worry much about whether the pain radiates to the back. Gualou shi removes the phlegm in this area (pointing to chest), so the prerequisite is knowing that your heart is wrapped by a layer of phlegm-fluid, making heartbeat extremely strenuous and causing heart disease. In traditional Chinese medicine (TCM), heart disease is interesting; it’s rarely that the heart itself has a major pathology; rather, the heart is affected by external factors. So to treat heart disease, first remove the dampness, cold, and phlegm fluid stuck in the chest. Gualou, Xiebai, and Banxia are recognized; Xiebai looks like the bulb of scallion, translucent. Fresh Xiebai crushed for medicine is best; dried Chinese medicine store Xiebai is less effective.
These three herbs decocted together, when drinking, add a small cup of sorghum liquor to the soup bowl; this is very effective. These two formulas of Group A mainly address chest oppression and pain, the sensation of chest stuffiness and aching. Don’t care for what Western medicine calls your specific heart disease—valve disease or others—just if you have chest tightness and pain, this formula can be used. If the pain radiates to the back, that’s okay too. When the chest pain is “stuffy,” this formula works well clinically. But if illness is severe, clinical strength may be insufficient; thus, how to make decoctions effective must be learned carefully. Radiating to the back is included.
Next is Group B herbs. What are Group B herbs? They are used when there is a feeling of something pressing inside. Basically, the sensation of oppression lies more toward the outside, close to the ribs. Group A herbs’ pain is nearer the ribs.
Group B herbs are Zhishi Xiebai Guizhi Houpo Decoction and Guizhi Ren Shen Decoction; Ren Shen Decoction is Lizhong Tang, so this is Lizhong Tang plus Guizhi. When you see a formula with Zhishi and Houpo, and one that fully includes Lizhong Tang, you know this treats valve disease. In TCM, to treat heart valve disease, you treat the spleen and stomach. So the person must have a very good, active spleen and stomach for the valve to improve because the heart valves correspond closely with spleen and stomach function.
Group B treats valve disease states. The main symptom is a feeling that something inside the chest cavity is pressing, stretching your feelings.
So earlier, Group A’s main symptom is a flat, stuffy feeling like suffocation, with rib area pain upon breathing; Group B herbs’ symptoms are inner pressure like something pushing out from the inside, causing pressing pain. Can you distinguish the symptoms of Group A and B herbs? Group A pain is on the ribs, resembling “Xianxiong” syndrome without heat but cold. Group B’s pain is like something pushing from inside out, mostly linked to valve disease.
In Western medicine, valve disease corresponds to the least manageable condition by Zhi Gan Cao Decoction (Zhigancao Tang), which is poor for valve disease. Valve disease requires the base of formulas like the ones mentioned.
Why two formulas? Think about it: if the patient just had an onset and the spleen-stomach has just started to lose vigor, just use Zhishi Houpo to recover spleen-stomach vitality. But if it’s a slow, chronic old illness caused by a debilitated spleen-stomach, then use Lizhong Tang base plus Guizhi to supplement heart yang. That’s logical: gradually improve the spleen-stomach, then with adequate spleen-stomach support, valve disease is cured.
Symptomatically, Group B’s pain feels like inside pushing outward; pathomechanistically in Western medicine, this is valve disease. The pain is described as “chest fullness and hypochondriac reflux stabbing the heart,” with pain location stretching that can extend from Group A’s front chest area to Group B’s side rib area, indicating internal traction.
Now let’s look at Group C. Group C is Fuling Xingren Gancao Decoction and Chenpi Zhishi Shengjiang Decoction. Group C mainly acts on the lungs. When a person has an attack, they either have a heart attack or simply asthma. Our Assistant Chen takes Fuling Xingren Gancao Decoction directly during asthma attack.
The main symptom for Group C, especially Fuling Xingren Gancao Decoction, is wheezing with heart palpitations (“pup pup pup pup” beating in the chest). Chenpi Zhishi Shengjiang Decoction’s main symptoms are throat obstruction or stomach fullness. Fuling Xingren Gancao acts on chest wheezing and palpitations; Chenpi Zhishi Shengjiang treats throat or stomach obstruction.
If the stomach is bloated, use Chenpi Zhishi Shengjiang Decoction, even without heart disease, to treat bloating.
Next, the first group of medicines: Yiyifuzi Baijiang Powder (likely a mispronunciation of Yiyifuzi San). This powder is said to treat chest bi that is “sometimes slow, sometimes acute.” The details of the variation are omitted here. This means chest spasms occasionally occur at the chest, sometimes mild; not severe angina, no need for nitroglycerin spray. The powder can be used. Of course, Aconite (Fuzi) must be well prepared, and Yiyi and Fuzi are ground into powder. You can take it as powder, which expels wind-dampness from the area.
I wouldn’t connect this directly to rheumatic heart disease, but some medical friends learned that children get enterovirus infections, which lately are widespread, such as hand-foot-and-mouth disease; it’s enterovirus. Adults may harbor the virus without symptoms but later develop rheumatic heart disease. In mainland China, people take Yiyifuzi San to prevent rheumatic heart disease, therefore blocking its development. You can also explain it as dispelling wind, dampness, and cold. Or say Yiyifuzi is a good formula for cleaning blood vessels; thus, for coronary heart disease with vessel obstruction, taking Yiyifuzi gradually helps clear blood vessels. So the main symptom here is occasional pulling pain, not severe. Stronger pain needs other medicines.
Next is Shengjiang Guizhi Zhishi Decoction. This is used contrastingly with Group B. Recall Group B’s Zhishi Xiebai Houpo Decoction and Guizhi Ren Shen Tang treat the sensation of something pressing inside. Shengjiang Guizhi Zhishi Decoction is opposite—it’s a feeling that something in the middle is being pulled downwards, while Group B’s is pushing up. So if your heart disease symptoms include the sensation of the heart being pulled down or entrapped, use this formula. This also applies to heart internal organ ptosis or prolapse; it addresses imbalance causing the heart to be pulled down.
Aconite Chishi Zhi Pill (Wutou Chishi Zhi Wan) is Group E (A, B, C, D, E). This is for true heart pain, the severe kind where you feel like you’re going to die during attack. Once you’ve had an episode so serious the angina feels like death, then use Wutou Chishi Zhi Pill. Its standard main symptom is heart pain piercing through to the back, back pain reaching the heart. Severe angina involves heart pain radiating to the back kidney area (Xinyu). It’s said that Fuzi and Wutou act respectively on the heart and the back Shu points, linked by Chishi. Fuzi, dry ginger, and prickly ash act fastest on driving cold from the heart among many Chinese herbs. When I take medicine containing significant prickly ash, I distinctly feel a thin spicy line—thinner than a sewing thread—running from my stomach directly to where the heart lies in the body. If you take prickly ash pills, you can directly sense this pathway inside your body, like a thin needle stitching from the stomach to the heart. This prickly ash as a guiding herb is truly marvelous.
Starting from Jueyin channel, this reaches the Gaohuang (heart area), so Wumei Pill is also a formula for heart disease maintenance, if not too severe. Mr. Ni Haixia said the main symptom is a persistent yellow coating on the root of the tongue that never goes away. This yellow coating is in the Jueyin area, in the Gaohuang, containing hot phlegm that cannot be removed, causing heart disease. So Wumei Pill is also applicable. Wutou Chishi Zhi Pill drives cold from the corporeal heart (not center midline, but the heart region) to drive out cold qi or it will be “true heart pain” in TCM, which is deadly.
Earlier we discussed Group B’s Lizhong Tang plus Guizhi. Lizhong Tang’s abdomen palpation diagnoses the heart region, so you know the digestive tract has a connection with the heart. Jiu Tong Wan uses strong hot purgatives to drive out pathological substances stuck in the Gaohuang area. This is strong medicine. If you use medicine like Badou (Croton seed) or Langdu (Stellera), they are potent and guided by Wuzhuyu, which travels the Jueyin channel to the Gaohuang to expel cold.
There is also Xuanfuhua Decoction and Banxia Mahuang Pills. Xuanfuhua Decoction, in the “Jinkui Yaolue,” is categorized under liver constraint with cold stagnation in the liver. People with liver constraint like having their chest pressed or stepped on. The pharmacology is not discussed; mainly the symptom is liking chest pressure. If you cannot get Xinjiang herbs, use Sangbaipi and Qicao as substitutes. Chew Xuanfuhua at the pharmacy; only if it lacks a bitter taste is it effective; those with salty taste are most effective. If it is bitter without salty taste, it is less effective.
Banxia Mahuang Pills address heart discomfort described as “heart palpitations below the heart.” It feels like the stomach and heart collide. Imagine your heart is fine, but all the organs below it are too large and crowd the heart, causing particular pressure. Then take weight-loss herbs to slim the lower organs; once they shrink, the heart has more room to move, which is what Banxia Mahuang Pills do.
Aside from heart disease, an important formula is Mufangji Decoction. When persons with heart disease attack, they often experience wheezing and dark facial complexion; we use Mufangji Decoction for many heart disease cases.
Classic prescriptions for treating heart disease are roughly covered here. For example, earlier we said “Jie Xiong” without major heat, water retention in the chest ribs. For water retention in the chest ribs, Mufangji Decoction is also very effective; its main symptom is dark face and wheezing, which is water retention in the chest ribs.
Regarding Da Xianxiong Decoction, if there is sweat on the head but none on the body, and the person has “Jie Xiong,” but neither head nor body has sweat, which formula is that? Shizao Decoction (Ten Jujube Decoction). If no sweat even on the head, then it’s Shizao Decoction. If these few formulas are studied together later, there will be some variations.
Source: Caiyun Changzai